MEDICARE: KIMBERLY LAVITA CLAYTON BROWN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME88022	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	593287185	OTHER	FL	TID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306830617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LAVITA CLAYTON BROWN MD

Provider Business Mailing Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 101
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	386-231-3615
Fax Number	:	386-231-3614

Provider Business Practice Location Address
First Line	:	305 MEMORIAL MEDICAL PKWY STE 101
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5169
Country	:	US
Telephone Number	:	386-231-3615
Fax Number	:	386-231-3614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	09/02/2025

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